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Face Down Recovery After Macular Hole Surgery May Be Unnecessary

Oct 09, 2013 - 0 comments
Tags:

Macular Hole Surgery

,

FACE DOWN POSTION



From one of the most prestigious medical journals:

OPHTHALMOLOGY   V120 #10 Pages 1998-2003 October 2013

Objective

To demonstrate the efficacy of broad internal limiting membrane (ILM) peeling and 20% sulfur hexafluoride (SF6) endotamponade with no face-down positioning in the surgical repair of idiopathic macular holes (MHs).

Design

Retrospective study.

Participants

Sixty-eight idiopathic MH cases in 68 eyes of 65 patients.

Methods

All idiopathic MH surgeries by 1 surgeon between March 2009 and December 2012, performed using broad ILM peeling, 20% SF6, and no face-down positioning, were reviewed. No cases were excluded. Surgeon method included 23-gauge or 25-gauge pars plana vitrectomy with induction of posterior vitreous detachment (if necessary). Indocyanine green dye (0.08 mg/ml in D5W) was injected slowly, allowed to stain for 60 seconds, and then removed. The ILM was broadly peeled to the vascular arcades (approximately 8000 μm in diameter), followed by 2 fluid–air exchanges, separated by 5 minutes, and an air–20% SF6 exchange. Patients maintained reading position for 3 to 5 days and were followed up at least for 1 month. Exact binomial distributions were used to establish 95% confidence intervals, and the 1-way analysis of variance was used to compare preoperative and postoperative intraocular pressures (IOPs).

Main Outcome Measures

Single-procedure MH closure rate, mean postoperative best-corrected visual acuity (BCVA), incidence of cataract, and IOP.

Results

Three patients (4.6%) had bilateral MH and 9 patients (13.8%) had recurrent MH (mean duration from previous surgery, 8.3±5.5 years; range, 1–16 years). Twenty-one MH (30.9%) were stage 2, 27 (39.7%) were stage 3, and 20 (29.4%) were stage 4. Five MH had a basal diameter of more than 1000 μm. Mean MH basal diameter was 609.6±226.2 μm. Mean preoperative BCVA was 0.68±0.29 logarithm of the minimum angle of resolution (logMAR) units (Snellen equivalent, 20/95), and mean most recent postoperative BCVA was 0.28±0.18 logMAR units (Snellen equivalent, 20/38). The single-procedure MH closure rate was 100% (95% confidence interval, 95%–100%), and no complications were observed.

Conclusions

Macular hole surgery with broad ILM peeling, 20% SF6 gas, and no face-down positioning is highly effective in the surgical treatment of idiopathic MH with efficacy comparable with methods that use longer-acting gas endotamponade, face-down positioning, or both. In our series, this method eliminated the morbidity associated with postoperative face-down positioning.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.



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